A leprosy patient on multidrug therapy presents after 8 months with crops of tender erythematous nodules over the limbs, fever and joint pains. Skin smear shows fragmented bacilli. Neutrophilic infiltration of the nodules is seen on biopsy. The best initial drug for this reaction is:

• A Clofazimine withdrawal only
• B Prednisolone alone as definitive therapy
• C Thalidomide ✓
• D Aspirin as monotherapy

Explanation

This is erythema nodosum leprosum, the type 2 lepra reaction, an immune complex mediated vasculitis occurring in multibacillary disease. Thalidomide is the most effective agent, acting through TNF-alpha suppression, though it is strictly avoided in women of childbearing potential because of phocomelia. Steroids are used when thalidomide is unsuitable. Multidrug therapy should generally be continued during the reaction.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.